Art Therapy After Trauma: What the Research Actually Shows

There is a specific reason people go looking for art therapy after something happened to them. Talking about it does not work. Not because they are unwilling, but because the account breaks down when they try to give it: the words come out flat, or they cannot find the thread, or the shame arrives before the sentence does.

So the proposition is appealing. Make something instead. Get at it sideways.

It is a more interesting proposition than most articles admit, and the evidence behind it is thinner than most articles admit. Both of those are worth knowing, and they point to a reasonably clear conclusion about where art-based work actually fits.

The Idea Behind It Is a Real Theory

This is not a vague claim that making things is nice. It rests on a specific model of how traumatic memory is stored.

Dual-representation theory, developed by Chris Brewin and colleagues, holds that memories of traumatic events exist in more than one form: sensory representations that are not verbal, alongside the verbal, contextualized kind of memory that lets you tell someone what happened and when. The difficulty people describe, where an event is vividly present but cannot be narrated, fits that split.

From there the proposal is straightforward. In the account given by Schnitzer, Holttum and Huet in their 2021 review, art-making reaches the non-verbal representation first, and verbal elaboration about the image afterwards engages the contextual kind, with the possibility that the two systems reconnect. Whether or not that final step is established, the first part explains the appeal: you are working with the version of the memory that is actually available.

There are two further mechanisms in the same review worth naming. Making an image puts a certain amount of distance between you and the material, which can make strong feeling more containable. And clients are not required to explicitly talk about the traumatic experience, which matters particularly for people whose main obstacle is shame or guilt rather than reluctance.

What the Reviews Actually Found

Now the uncomfortable part, and there is no way to report it kindly.

Schnitzer, Holttum and Huet reviewed 20 studies of art therapy for adults with PTSD in the International Journal of Art Therapy in 2021. Effects were reported across most PTSD symptom clusters, especially avoidance and social withdrawal. But 10 of the 20 studies were case studies, only two included any control condition, none reported a reasonable follow-up period, and the reviewers' own summary of the literature was that the quality of reviewed articles was poor. Twelve of the 20 involved veterans or service members, which also limits how far the findings travel.

The one randomized comparison they found, by Campbell and colleagues in 2016, tested cognitive processing therapy with and without art therapy. Both groups improved. There was no difference between them. The samples were 5 and 10 people, which is too small to detect a difference if one exists, so the fair reading is that the question was not answered rather than answered in the negative.

A 2025 meta-analysis in BMC Psychology by Wang and colleagues pooled seven controlled studies of creative arts therapies across 665 adults and found an overall effect favoring the therapies, with a standardized mean difference of 1.98. It comes with serious caveats that the authors state themselves: heterogeneity was 98 percent, which is about as high as that measure goes, only seven studies met inclusion, the result depended heavily on one of them, and they describe their own findings as preliminary evidence to be interpreted with caution.

For comparison, EMDR and cognitive processing therapy and prolonged exposure are all recommended for PTSD in the 2023 clinical practice guideline from the US Departments of Veterans Affairs and Defense, on the basis of a body of trials art therapy does not currently have. That is not a verdict on art therapy. It is the difference between a promising rationale and an established treatment, and it should shape what you expect.

So Where Does Art Therapy Fit?

The most useful answer comes from the reviewers themselves, who were in a position to see the whole literature and still made a specific recommendation. Schnitzer, Holttum and Huet suggest using art therapy when avoidance, or feelings of guilt and shame, make engaging in standard talking therapies difficult.

That is a narrower claim than "art therapy treats trauma," and it is more useful. It positions art-based work as a way in: something that can make it possible to engage at all, for a person who would otherwise not start, or would start and drop out. Which is a real contribution, given that avoidance is a symptom of the condition being treated and a leading reason people leave trauma therapy.

Read that way, the honest framing is not art therapy instead of the better-evidenced approaches. It is art therapy as a route toward being able to use them, or alongside them. Several of the studies in that review involved art therapy delivered as part of a wider treatment package, which is part of why attributing the improvement to the art is difficult, and also a fair picture of how it is usually done.

If your difficulty is specifically that you cannot narrate the event, it is worth knowing that EMDR was designed around that problem too and asks for much less verbal account than people expect, which How Do You Heal From Something You Can't Talk About? explains. And if the experience you are describing is one of a body that reacts without your permission, Why Your Body Remembers What Your Mind Forgot covers that ground.

One Thing Worth Asking About

The words in this area are used loosely, and the distinction is worth having.

Art therapist is a specific professional title with its own training and credential. The American Art Therapy Association's position is that practicing art therapy is outside the scope of practice of professionals who are not art therapists. Separately, plenty of licensed therapists use art-based and creative methods within their own training and scope, which is a legitimate thing and is not the same as art therapy delivered by a credentialed art therapist.

Neither is a trick. But they are different, and if the credential matters to you, the question to ask any practice is simply which one they are describing.

Where to Start in Arizona

If talking about it has been the barrier, that is worth saying out loud at the beginning rather than discovering in session four. It changes what a therapist suggests and the order they suggest it in.

The Healing Effect works with clients across Arizona, in person and by telehealth for clients located in the state. There is more about trauma work on our trauma and PTSD page, and you can ask us a question through our contact form, including about what approach is likely to suit what you are bringing.

One closing thought on reading this kind of evidence. Thin evidence is not the same as evidence of no effect, and a hundred clinicians reporting that something helped their clients is information, just not the kind that settles an argument. The reasonable position is to take the mechanism seriously, hold the outcome claims loosely, and notice that the people who know this literature best recommend it for a particular problem rather than for everything.

Does art therapy work for trauma?

The evidence is not strong enough to say so confidently. A 2021 review of 20 studies reported effects across most PTSD symptom clusters but judged the quality of the literature poor, with half the studies being case reports, only two controlled, and none with reasonable follow-up. A 2025 meta-analysis of seven controlled studies found an effect favoring creative arts therapies but described it as preliminary, with very high heterogeneity. The reasonable summary is a promising rationale with thin outcome evidence.

Why would making art help with something verbal therapy cannot reach?

Dual-representation theory proposes that traumatic memories are held in non-verbal sensory form as well as in verbal, contextualized form. The proposal is that art-making engages the non-verbal representation first, with talking about the image afterwards engaging the contextual kind. Reviewers also note that making an image creates some distance from the material and does not require explicitly describing the event.

Is art therapy as effective as EMDR for PTSD?

No comparison supports that claim. EMDR, cognitive processing therapy and prolonged exposure are recommended for PTSD in the 2023 VA and Department of Defense clinical practice guideline on the basis of a trial literature art therapy does not currently have. That is a difference in how much has been tested, not proof that art-based work does nothing.

When is art therapy most likely to be worth trying?

The reviewers of the 2021 systematic review suggest considering it when avoidance or feelings of guilt and shame make engaging in standard talking therapies difficult. That frames it as a way to make engagement possible, alongside or ahead of the better-evidenced approaches, rather than as a substitute for them.

Do I need to see a credentialed art therapist?

It depends what you are looking for. Art therapist is a specific professional title with its own training, and the American Art Therapy Association's position is that practicing art therapy falls outside the scope of practice of professionals who are not art therapists. Separately, many licensed therapists use art-based methods within their own scope and training. Both exist; they are not the same thing, and any practice can tell you which they mean.

The Healing Effect is not a crisis service. If you are in crisis or thinking about harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline, available 24 hours a day, 7 days a week.

Sources:

Schnitzer G, Holttum S, Huet V. A Systematic Literature Review of the Impact of Art Therapy Upon Posttraumatic Stress Disorder. International Journal of Art Therapy. 2021 (20 studies of adults with PTSD; 10 case studies; only Campbell et al. 2016 and Morgan and Johnson 1995 included control conditions; no study reported a reasonable follow-up period; quality of reviewed articles judged poor; dual-representation theory as the proposed mechanism; the recommendation to consider art therapy when avoidance or guilt and shame make talking therapies difficult).

Campbell M, et al. 2016, reported in the review above (randomized comparison of cognitive processing therapy with and without art therapy; both groups improved; no between-group difference; samples of 5 and 10).

Wang J, Zhang B, Yahaya R, Abdullah A. Colors of the mind: a meta-analysis of creative arts therapy as an approach for post-traumatic stress disorder intervention. BMC Psychology. 2025;13:32 (7 controlled studies, 665 adults; standardized mean difference 1.98, 95 percent confidence interval 0.16 to 3.80; heterogeneity 98 percent; findings described as preliminary and to be interpreted with caution; result heavily dependent on one included study).

Brewin CR, et al. Dual-representation theory of post-traumatic stress disorder, described in the Schnitzer, Holttum and Huet review above rather than read at source.

US Department of Veterans Affairs and US Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. 2023 (EMDR, cognitive processing therapy and prolonged exposure among the recommended psychotherapies). Recommendation list read through the International Society for Traumatic Stress Studies summary rather than the full guideline.

American Art Therapy Association. Position that the practice of art therapy is beyond the scope of practice of non-art-therapist professionals.